<div class="container">
    <div class="right_contents" style="float: left;">
<!--        <h2 class="pagetitle">ONLINE AFFIDAVIT 
            <div class="clickmsg"><a href="#">Click here</a> for step by step guide on how to fill the affidavit</div>
        </h2>-->
        <div class="bdytext">
<!--            <strong>TO BE FILLED BY A STUDENT</strong><br> 
            Fields marker with * are compulsory.
            <ol>
                <li>If you do not have an E mail address please create one before you fill in this form.</li>
                <li>If your mother or father or guardian does not have a phone or a mobile phone or email then please give the numbers /email of      their friends or relations or neighbors.</li>
                <li>If you do not have a mobile number, then please give the mobile number of your friend in the college.</li>
            </ol>
            <p>After filling this form successfully you will receive the Student's Anti Ragging Affidavit and the Parents Anti Ragging Affidavit in your Email. Please print both the Affidavits, sign them yourself, request your parents to read the details and request them to sign their affidavit and then present both at your college at the time of registration, each year.</p>
            <p>After filling this form successfully you will receive the Student's Anti Ragging Affidavit and the Parents Anti Ragging Affidavit in your Email. Please print both the Affidavits, sign them yourself, request your parents to read the details and request them to sign their affidavit and then present both at your college at the time of registration, each year.</p>-->

            <h3 class="frm-title">Personal Details<span>step #1/5</span></h3>	
            <div class="myform">
                <div class="frmrow">
                    <div class="col1-3 mr1">
                        <label>Student's Last Name:<span>*</span></label>
                        <?php echo $form->textField($model, 'last_name', array('maxlength' => 45, 'class' => 'required')); ?>
                        <?php echo $form->error($model, 'last_name'); ?>
                    </div>
                    <div class="col1-3 mr1">
                        <label>Student's Middle Name:<span>*</span></label>
                        <?php echo $form->textField($model, 'middle_name', array('maxlength' => 45, 'class' => 'required')); ?>
                        <?php echo $form->error($model, 'middle_name'); ?>
                    </div>
                    <div class="col1-3">
                        <label>Student's First Name:<span>*</span></label>
                        <?php echo $form->textField($model, 'first_name', array('maxlength' => 45, 'class' => 'required')); ?>
                        <?php echo $form->error($model, 'first_name'); ?>
                    </div>
                    <div class="clrfx"></div>
                </div>

                <div class="frmrow">
                    <div class="col1-3 mr1">
                        <label>Gender:<span>*</span></label>
                        <div class="radioBg">Male <?php
                        echo $form->radioButton($model, 'gender', array('style' => 'margin-right:18px;',
                            'value' => '1', 'uncheckValue' => null
                        ));
                        ?></div>
                        <div class="radioBg">Female <?php
                            echo $form->radioButton($model, 'gender', array('style' => 'margin-right:18px;',
                                'value' => '2', 'uncheckValue' => null
                            ));
                        ?></div>
                    </div>
                    <div class="col1-3 mr1">
                        <label>Nationality:<span>*</span></label>
                        <?php echo $form->textField($model, 'nationality', array('maxlength' => 45, 'class' => 'required')); ?>
                        <?php echo $form->error($model, 'nationality'); ?>
                    </div>
                    <div class="col1-3 mr1">
                        <label>Student's Mobile Number:<span>*</span></label>
                        <?php echo $form->textField($model, 'mobile_no', array('class' => 'required','title'=>"Please enter 10 digit mobile number!",'minlength'=>"10",'maxlength'=>"10")); ?>
                        <?php echo $form->error($model, 'mobile_no'); ?>
                    </div>
                    <div class="clrfx"></div>
                </div>
                <div class="frmrow">

                    <div class="col1-3 mr1">
                        <label>Alternate Number(Friend):<span>*</span></label>
                        <?php echo $form->textField($model, 'alterne_no', array('class' => 'required phone')); ?>
                        <?php echo $form->error($model, 'alterne_no'); ?>
                    </div>
                    <div class="col1-3">
                        <label>Landline Number:<span>*</span></label>
                        <?php echo $form->textField($model, 'landline_no', array('class' => 'required')); ?>
                        <?php echo $form->error($model, 'landline_no'); ?>
                    </div>
                    <div class="col1-3 mr1">
                        <label>Student's Email ID:<span>*</span></label>
                        <?php echo $form->textField($model, 'email_address', array('class' => 'email required')); ?>
                        <?php echo $form->error($model, 'email_address'); ?>
                    </div>
                    <div class="clrfx"></div>
                </div>


                <div class="frmrow">
                    <div class="col1-3 mr1">
                        <label>Address1:<span>*</span></label>
                        <?php echo $form->textField($model, 'address_line1', array('class' => 'required')); ?>
                        <?php echo $form->error($model, 'address_line1'); ?>
                    </div>
                    <div class="col1-3">
                        <label>address2:<span>*</span></label>
                        <?php echo $form->textField($model, 'address_line2', array('class' => 'required')); ?>
                        <?php echo $form->error($model, 'address_line2'); ?>
                    </div>
                    <div class="col1-3 mr1">
                        <label>City:<span>*</span></label>
                        <?php echo $form->textField($model, 'city', array('class' => 'required')); ?>
                        <?php echo $form->error($model, 'city'); ?>
                    </div>
                    <div class="clrfx"></div>
                </div>



                <div class="frmrow">

                    <div class="col1-2">
                        <label>State:<span>*</span></label>
                        <?php echo $form->dropDownList($model, 'state_id', GxHtml::listDataEx(AmanState::model()->findAllAttributes(null, true))); ?>
                        <?php //echo $form->textField($amanStudentCollegeDetails, 'state_id', array('class' => 'required')); ?>
                        <?php //echo $form->textField($model, 'state_id', array('class' => 'required')); ?>
                        <?php echo $form->error($model, 'state_id'); ?>
                    </div>
                    <div class="clrfx"></div>
                </div>



            </div>						
        </div>
    </div>
</div>








